Obamacare born in controversy, rolls out still mired in dispute

After years of attempts to defend, defame and now defund it, the Affordable Care Act’s watershed moment is finally here. On Tuesday, the health care law’s online insurance marketplaces are scheduled to debut in every state, giving Americans their first opportunity to kick the tires and purchase insurance benefits that might not have been available to them before.

A baby seems to look on as a doctor uses a portable computer to enter information from his exam into an electronic medical records system.
Raleigh News & Observer/MCT

After years of attempts to defend, defame and now defund it, the Affordable Care Act’s watershed moment is finally here.

On Tuesday, the health care law’s online insurance marketplaces are scheduled to debut in every state, giving Americans their first opportunity to kick the tires and even purchase new health insurance benefits that might not have been available to them before.

While most states are still working out some technological kinks in their systems, the launch of the high-tech marketplaces ushers in a new era of comparative shopping that’s predicted to ultimately make health coverage options more transparent and, perhaps, far less daunting.

The marketplaces are opening amid a raging battle in Congress, where Republicans have persistently tried to repeal Obamacare outright. During the current debate over temporarily funding the government when the fiscal year ends Monday night, GOP critics have said they’ll allow the government to shut down if defunding Obamacare isn’t part of the budget deal.

But even if the government shuts down in a dispute over the law’s funding, the health care law will continue to be implemented because much of the funding is mandatory and not part of Congress’ annual discretionary appropriations. Funding could be stopped only if the law were repealed.

Run by either the federal government or the states themselves, the marketplaces will allow individuals, families and small businesses to enroll in health plans that the law dictates must cover a wide range of essential benefits and can’t deny coverage because of current or past health problems.

Marketplace plans also will limit older people from being charged more than three times the amount of young adults, ban spending limits for medical expenses and prohibit rate differences based on gender, occupation and medical claims history.

People who earn up to four times the federal poverty level – $46,000 for an individual this year – can get federal subsidies, or “tax credits,” to help purchase marketplace coverage. Many of these same people will get additional subsidies that limit their out-of-pocket costs, such as co-payments and deductibles.

The health care law requires most Americans to have health insurance beginning in 2014 or face a fine, which will be levied when they file their income taxes next year.

Recent computer problems suggest that the marketplace debuts may not go smoothly. Small-business enrollments in 36 states where the federal government either will run or jointly operate the marketplaces have been postponed until November because of technical glitches.

Maryland, Oregon and the District of Columbia have delayed key marketplace functions until computer problems are resolved.

“Of course, there’ll be glitches. And we’ll fix them. . . . I expect we’ll have lots of bumps,” said Christine Ferguson, the director of the Rhode Island marketplace.

“We aren’t supposed to get it right on day one,” Shepherd said. “We want the opportunity to make it better and better. And we need to start with what we can do and do it well. And then we can keep building, keep perfecting and make it better and better as time goes on.”

Tuesday’s marketplace debut isn’t likely to spawn a rush of eager buyers, because people have until Dec.15 to buy coverage that begins on Jan. 1. During that time, many people will interact with the marketplace more than a dozen times before they make purchases, said Heather Howard, the state network program director at the Robert Wood Johnson Foundation, a public health philanthropy.

“October 1 is just a start. It’s not a magical date,” Howard said.

Most states probably will see spikes in marketplace activity just before the Dec. 15 deadline for enrolling by Jan. 1, and just before the 2014 open enrollment period ends March 31, Howard said. An estimated 7 million people are expected to have enrolled by then.

Buying coverage before March 31 will fulfill the mandate that individuals have health insurance by 2014.

In addition to online enrollment, marketplaces will have telephone call centers to help people sign up, as well as community enrollment workers, or “navigators,” who’ve been trained to assist with enrollment, along with licensed insurance agents and brokers.

But enrollment efforts will have to overcome a confused public that, polls suggest, still doesn’t fully understand the health law or even like it. Many others are confused about whether they need to get marketplace coverage. Add to that skepticism of government in general, and the enrollment challenge for the marketplaces is immense.

“That skepticism that people have about something that was originated in government . . . is a really significant hurdle,” Ferguson said.

To help its cause, the Obama administration will begin a multi-million-dollar advertising campaign Monday urging people to sign up for coverage in states that chose not to expand their Medicaid programs.

One of those states is Georgia, where Republican U.S. Rep. Lynn Westmoreland took issue with the government’s upcoming ad buy, calling it an “overreach of power and authority by using the taxpayers’ money to promote the very law they so ubiquitously reject.”

In California, where 800,000 to 1.3 million tax credit-eligible people are expected to enroll in coverage, Peter Lee, the executive director of the state’s marketplace, said he expected very few people to enroll in October.

But in test-marketing among California’s tax credit-eligible residents, Lee found an eager customer base.

“If you put before them in concrete terms what their premiums will be and what the benefits are, over 80 percent say that they’re either committed to buying or very receptive,” Lee said. “So we’re very optimistic that when we put the facts in front of folks, it’s going to look good.”